Healthcare Provider Details

I. General information

NPI: 1114524782
Provider Name (Legal Business Name): DENALAINE ABRAHAN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 W TOWN PKWY
ALTAMONTE SPRINGS FL
32714-3845
US

IV. Provider business mailing address

12303 WYCLIFF PL
TAMPA FL
33626-2632
US

V. Phone/Fax

Practice location:
  • Phone: 813-892-8244
  • Fax:
Mailing address:
  • Phone: 813-892-8244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA29868
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: